Association between Chronic Inflammation of Basal Plate and Decidua Existences with Placenta Accreta Spectrum

Yuktiana Kharisma, Meike Rachmawati, Abdul Hadi Hassan, Ismet Muchtar Nur, Hasrayati Agustina, Sri Suryanti

Abstract


The placenta accreta spectrum (PAS) is an abnormal placenta condition with a high level of morbidity and mortality in both the mother and fetus. The PAS has a multifactorial etiology, one of which is a chronic inflammation of the basal plate (CIBP) and the decidual existences (DE). The study aims to analyze the association between CIBP and DE with PAS. It was an analytical observational with a cross-sectional study design on 50 placentae (25 PAS paraffin block, 25 standard placenta samples) from Dr. Hasan Sadikin General Hospital and other health centers that meet the inclusion and exclusion criteria. The data are taken from PAS patients from January 2015–December 2020. All samples will be stained with hematoxylin-eosin (HE), then undergo histopathological examination. The result of the studies analyzed statistically using Fisher's exact. CIBP in PAS was found in 21/25 cases, while in the normal placenta was found in 16/21 patients. The DE is positive in 15/25 cases of PAS, whereas the normal placenta was found in all cases. The association between CIBP and PAS is insignificant statistically (p=0.19), while the DE showed a significant relationship with PAS (p=0.00). The presence of the decidua is related to the regulation of trophoblastic invasion into the myometrium in PAS cases. CIBP can occur due to the reaction of decidua tissue to trophoblastic invasion or an infectious agent. The pathogenesis of PAS needs further understanding so that the appropriate therapy can be found for its prevention and management.


Keywords


Decidua: inflammation; spectrum placenta accreta

Full Text:

PDF

References


Silver RM, Branch DW. Placenta accreta spectrum. N Engl J Med. 2018;378(16):1529–536.

Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018;140(3):274–80.

Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733–42.

Zhang D, Yang S, Hou Y, Yan S, Shi H, Gu W. Risk factors, outcome and management survey of placenta accreta in 153 cases: a five-year experience from a hospital of Shanghai, China. Int J Clin Exp Med. 2017;10(8):12509–16.

Pegu B, Thiagaraju C, Nayak D, Subbaiah M. Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstet Gynecol Sci. 2021;64(3):239–47.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458–61.

Garmi G, Salim R. Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int. 2012;2012:873929.

Jauniaux E, Chantraine F, Silver RM, Langhoff-Roos J; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int J Gynaecol Obstet. 2018;140(3):265–73.

Higgins MF, Monteith C, Foley M, O'Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous cesarean section. Eur J Obstet Gynecol Reprod Biol. 2013;171(1):54–6.

Kandil MAS, Sayyeda TM, Salaha A, Al Gilanyb NMA. Maternal and neonatal outcomes of placenta accreta: a descriptive case series study. Menoufia Med J. 2019;32(1):368–74.

Pan XY, Wang YP, Zheng Z, Tian Y, Hu YY, Han SH. A marked increase in obstetric hysterectomy for placenta accreta. Chin Med J (Engl). 2015;128(16):2189–93.

Balayla J, Bondarenko HD. Placenta accreta and the risk of adverse maternal and neonatal outcomes. J Perinat Med. 2013;41(2):141–9.

Tsuzuki T, Okada H, Cho H, Tsuji S, Nishigaki A, Yasuda K, et al. Hypoxic stress simultaneously stimulates vascular endothelial growth factor via hypoxia-inducible factor-1α and inhibits stromal cell-derived factor-1 in human endometrial stromal cells. Hum Reprod. 2012;27(2):523–30.

Hannon T, Innes BA, Lash GE, Bulmer JN, Robson SC. Effects of local decidua on trophoblast invasion and spiral artery remodeling in focal placenta creta–an immunohistochemical study. Placenta. 2012;33(12):998–1004.

Goh WA, Zalud I. Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta. J Matern Fetal Neonatal Med. 2016;29(11):1795–800.

Laban M, Ibrahim EAS, Elsafty MSE, Hassanin AS. Placenta accreta is associated with decreased decidual natural killer (dNK) cells population: a comparative pilot study. Eur J Obstet Gynecol Reprod Biol. 2014;181:284–8.

Kim CJ, Romero R, Chaemsaithong P, Kim JS. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am J Obstet Gynecol. 2015;213(Suppl 4):S53–69.

Ernst LM, Linn RL, Minturn L, Miller ES. Placental pathologic associations with morbidly adherent placenta: potential insights into pathogenesis. Pediatr Dev Pathol. 2017;20(5):387–93.

Bartels HC, Postle JD, Downey P, Brennan DJ. Placenta accreta spectrum: a review of pathology, molecular biology, and biomarkers. Dis Markers. 2018;2018:1507674.

Wallace AE, Fraser R, Cartwright JE. Extravillous trophoblast and decidual natural killer cells: a remodeling partnership. Hum Reprod Update. 2012;18(4):458–71.

Jauniaux E, Burton GJ. Pathophysiology of placenta accreta spectrum disorders: a review of current findings. Clin Obstet Gynecol. 2018;61(4):743–54.

Dannheim K, Shainker SA, Hecht JL. Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination. Arch Gynecol Obstet. 2016;293(5):951–8.

Parra-Herran C, Djordjevic B. Histopathology of placenta creta: chorionic villi intrusion into myometrial vascular spaces and extravillous trophoblast proliferation are frequent and specific findings with implications for diagnosis and pathogenesis. Int J Gynecol Pathol. 2016;35(6):497–508.

Miller ES, Linn RL, Ernst LM. Does the presence of placental basal plate myometrial fibers increase the risk of subsequent morbidly adherent placenta: a case-control study. BJOG. 2016;123(13):2140–5.




DOI: https://doi.org/10.29313/gmhc.v10i2.9060

pISSN 2301-9123 | eISSN 2460-5441


Visitor since 19 October 2016: 


Free counters!


Global Medical and Health Communication is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.